Abstract
A 46-year-old male underwent a right adrenalectomy and a left upper lobectomy with an en-block resection of the involved chest wall. The proximal rib resections (third and fourth ribs) were performed at the costvertebral joints. Hemorrhage occurred from near the 3rd intervertebral foramen. The bleeding site was packed with oxycellulose to control the bleeding. Two hours after the operation, the patient complained of paraplegia due to spinal cord compression caused by swollen oxycellulose. An emergency operation was performed. The oxycellulose was carefully removed from the intervertebral foramen. Cerebrospinal fluid was exudated from the spinal canal, however, suggesting an iatrogenic subarachnoid-pleural fistula (ISPF). Autologous fat fragments individually combined with fibrin glue, was packed gently into the intervertebral foramen. The orifice of the foramen was then covered with a pericardial fat pad. The postoperative course was uneventful. This new technique is a direct and effective treatment for an ISPF.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bilsky MH, Downey RJ, Kaplitt MG, Elowitz EH, Rusch VW. Tension pneumocephalus resulting from iatrogenic subarachnoid-pleural fistulae: Report of three cases. Ann Thorac Surg 2001; 71: 455–7.
Heller JG, Kim HS, Carlson GW. Subarachnoid-pleural fistulae-management with a transdiaphragmatic pedicled greater omental flap: Report of two cases. Spine 2001; 26: 1809–13.
Da Silva VF, Shamji FM, Reid RH, del Carpio-O’Donovan R. Subarachnoid-pleural fistula complicating thoracotomy: Case report and review of the literature. Neurosurgery 1987; 20: 802–5.
Qureshi MM, Roble DC, Gindin RA, Scudamore HH. Subarachnoid-pleural fistula: Case report and review of the literature. J Thorac Cardiovasc Surg 1986; 91: 238–41.
Hofstetter KR, Bjelland JC, Patton DD, Woolfenden JM, Henry RE. Detection of bronchopleural-subarachnoid fistula by radionuclide myelography: Case report. J Nucl Med 1977; 18: 981–3.
Labadie EL, Hamilton RH, Lundell DC, Bjelland JC. Hypoliquorreic headache and pneumocephalus caused by thoraco-subarachnoid fistula. Neurology 1977; 27: 993–5.
Sarwal V, Suri RK, Sharma OP, Baruah A, Singhi P, Gill S, et al. Traumatic subarachnoid-pleural fistula. Ann Thorac Surg 1996; 62: 1622–6.
Nakasu Y, Itoh R, Nakasu S, Nioka H, Kidooka M, Handa J. Postoperative sella: Evaluation with fast spin echo T2-weighted high-resolution imaging. Neurosurgery 1998; 43: 440–6.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shimizu, K., Otani, Y., Ibe, T. et al. Successful treatment of subarachnoid-pleural fistula using pericardial fat pad and fibrin glue after chest wall resection for lung cancer. Jpn J Thorac Caridovasc Surg 53, 93–96 (2005). https://doi.org/10.1007/s11748-005-0008-8
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11748-005-0008-8